HEART-LUNG MACHINE

During an open-heart surgery (such as valve surgery), an

extracorporeal (i.e. outside the body) equipment called the heart-lung
machine takes over the functions of the heart and lungs, so that the
heart can be carefully stopped while the vital organs continue to receive
blood and oxygen. The surgeon can then operate in a blood-free surgical
field without interference from bleeding or the heart's pumping motion.
The principle of the heart-lung machine (also known cardiopulmonary
bypass) is actually quite simple. It permits the heart to be operated on
safely by maintaining the circulation of oxygenated blood throughout
the cardiovascular system. It represents a continuous loop; as the rich-
oxygen blood goes into the body, poor-oxygen blood returns from the
body and is drained into the pump completing the circuit. The machine
basically consists of a pump (to replace the heart) and an oxygenator (to
replace the lungs). Acting as a mechanical heart and lungs, it keeps
oxygen-rich blood flowing throughout the body after the patient's heart
has been carefully stopped. In a process called perfusion , the machine
receives the patient's blood, removes the carbon dioxide and other waste
products, adds oxygen, warms (or cools) the blood and pumps it back
through the body. Cooling the blood, in turn, lowers body temperature.
This helps protect the body's organs while the heart-lung machine is in
use. After the surgery is completed, the heart is restarted, the heart-
lung machine is stopped and the machine is disconnected from the
patient.
 Once using a heart-lung machine during open-heart surgery, a
powerful anticoagulant, Heparin should be given to the patient in order
to reduce the blood's ability to clot, reducing the risk of clots forming in
the heart-lung machine and within the tubes connected to the heart. The
heart-lung machine can perform other tasks. It can directly deliver
medications and anesthetic drugs into the recirculated blood. In this
way, medications arrive to the patient almost instantly by simply adding
them to the blood within the heart-lung reservoir. It can also minimize
blood loss by vacuuming up and recirculating any blood that may get
into the surgical field.

The shown below diagram illustrates a heart-lung machine pump

head. This type of mechanism is called a peristaltic pump. The blood to
and from the patient's body is carried in a length of sterile, clear plastic
(polyvinyl chloride) tubing known as cannulas. These cannulas, with
appropriate fittings to accommodate the tubing, are inserted into the
vessels to take blood from, and deliver blood to, the patient. Pumping
action occurs because the rollers on the rotating arm compress the
tubing carrying the blood, forcing the blood ahead of the compressed
section. This peristaltic action produces a wave like, pulsatile flow of the
blood through the tubing system.

The heart-lung machine, schematically shown below, uses five

pump heads; one for perfusion of the body, two suckers and two for
perfusion of the coronary arteries.
 The main perfusion system includes pump head 1 and a
combination heat exchanger / oxygenator. Some models separate these
units, having separate oxygenator and heat exchanger devices. The heat
exchanger consists of water coils isolated from, but thermally coupled
to, the blood. A temperature controller permits the pump operator to
keep the blood at a proper temperature and compensate for heat loss
through radiation from the lines. The input port of the oxygenator /
exchanger assembly is called the O2 –minus side, while the output port
is called the O2 –plus side.

Blood is taken from the patient's venae cava. A cannula is placed

into the superior venae cava and another into the inferior venae cava.
These lines are joined into a single piece of tubing through a Y-adapter.
The blood flows from the venae cavae through the tubing to the O2 –
minus side of the oxygenator / exchanger assembly. Another length of
tubing carries blood from the O2 –plus side of the assembly, through a
cannula inserted into the femoral artery. Pump heads 2 and 3 are used
as suckers. Pump head 2 has a vent function to perform in the heart,
while pump head 3 is shown as a suction device.

The surgeon can use the suction tip to collect blood that pools
during surgery; this blood is ordinarily lost unless it is auto-transfused
back to the patient. Blood from the suckers is delivered to a reservoir
tank, and then transferred into the oxygenator / exchanger assembly on
the O2 –minus side. The purpose of pump heads 4 and 5 is to perfuse
the coronary arteries. A piece of tubing is routed from a port on the O2
–plus side of the oxygenator through the pump heads to the cannulas
placed in the coronary arteries.

The heart-lung apparatus is provided with controls that

automatically maintain the proper temperature, maintain the pH of the
blood at its correct value and safeguard the patient against unwanted
changes in the volume and pressure of the blood.

The temperatures of the patient and the blood are both recorded
automatically at frequent intervals. Blood temperature is controlled by
a thermostat and electric heater in the recirculation loop. The pH
controller measures the pH value of the blood and adjusts the admission
of carbon dioxide to the oxygenator so as to maintain the pH near its
correct level of (7.38). The maintenance of the correct pH level is
essential if the blood is to perform its proper function for oxygen-
carbon dioxide transport to and from the tissues of the body.

The design of heart-lung machine should involve the four major

considerations:

1) The artificial lung to accomplish the required gas transfer.

2) The mechanical pumps to replace the heart action in moving the
blood from the patient's low-pressure venous system through the
machine and back into the patient's higherpressure arterial system.

3) The handling of the blood itself, which raises questions of chemistry,

materials of
construction and surgical cleanliness.

4) The system of control to provide for as much automatic performance

as possible during thecourse of the operation.